Postpartum Doula Planner

Name *

First

Last

Email *

Phone *

Address *

Estimated Due Date *

Birth Place *

Hospital
Birthing Center
Home

Partner Name

Children and Pets *

Share other members of your family and their names

Package Choices

Please choose the package that matches the support you are seeking. All packages can be adjusted to your needs, but this will give us a starting point.

How many weeks are you looking for support? (2 week minimum)

2 weeks
4 weeks
6 weeks

How many days a week are you needing support?

1-2
3-4
5 days a week

What times are best for your Postpartum visits?

Home visits will be 2-3 hours each. Choose what applies best.

What are your birth plans? How are you preparing?

What kind of parental leave do you and your partner have?

This is a sacred time that you need to heal and learn about your baby. It’s also the time for your baby to learn about you.

What kind of support do you have from family & friends?

Share how you feel they will be the best support

How will your partner support you? Check all that apply

Do you have any history of medical or mental health challenges?

Describe other sibling care

Will you be wanting visitors? How long would you like them to stay? (30 min, 1 hr, etc)

Do you need a meal train organized?

Selected Value: 0

Please start creating a list of those that offer to help after your birth

Describe and list any food preferences, allergies, or intolerance

Please be specific so we can make sure you are nourished in the best way

Current feeding plans for baby

Breastfeeding
Bottle feeding
Unsure and need more education

Birthing Classes & Preparation

Thoughts on Sleep

Share your concerns and what kind of support you need

Do you have a spiritual or faith preferences in your family? Share what would be most helpful for your care

Share a little about your home situation

Do you live with others? Do you have pets?

Describe household chores you'd like help with

What are your most important wishes or concerns about the Postpartum period?

Share what comes to mind. We want to support you the best way possible and allow this transition to be smooth and come with many joys

Choose other healing techniques you'd enjoy during our Postpartum time together

Will your need community support

After the first several weeks of healing and bonding with your new baby, you might have a desire to meet others in the community experiencing Postpartum. Will you need references?

Share any other needs or wishes

Postpartum Doula Planner

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